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LAO: Brown's Expansion of Managed Care Pilot Would Be 'Premature'

Wednesday, February 22, 2012

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LAO: Brown's Expansion of Managed Care Pilot Would Be 'Premature'

Wednesday, February 22, 2012

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Gov. Jerry Brown's (D) plan to rapidly expand a four-county pilot program that shifts individuals eligible for both Medi-Cal and Medicare into managed care plans is "premature," according to a report from the non-partisan Legislative Analyst's Office, California Watch reports. Medi-Cal is California's Medicaid program.

According to LAO estimates, the state has about 1.9 million so-called dual eligibles (Jewett, California Watch, 2/22).

Brown's administration has estimated that shifting patients faster would improve care and reduce state spending by $679 million in 2012 and by $1 billion in subsequent years.

LAO Recommendation

After reviewing Brown's plan, LAO said state lawmakers should reject the expansion of the pilot program "before the results from the demonstration have been properly evaluated, but proceed instead with the four-county demonstration."

State Official Supports Consolidation Plan

In related news, Toby Douglas, director of the Department of Health Care Services, testified during a legislative hearing that he supports a plan to transfer most functions of the state mental health and alcohol and drug departments to DHCS, which oversees Medi-Cal.

He said the plan would eliminate a "silo" approach to treatment and coordinate physical, mental and drug rehabilitation therapy.

However, patient advocates who also testified criticized the plan as a political maneuver that would not save the state money. Others said it would hinder accountability for those treating patients with mental health and substance misuse problems (California Watch, 2/22).

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I hear from everyone that provides services or receives services but what about those who pay for the care or trying to balance the budget? Fraud is out of control and use of the facilities is in excess. Managed care is the only possible solution and applying co-payments to sevices especially emergency rooms is the only way to avoid use when primary care is a fraction of the cost. The pilot program is a way to show it works. The DME crooks & drug users who cheat the system will never want Managed care.

February 24, 2012 at 11:22 AM

Debra Girard

This scares me because I have to see multiple specialists, and I am afraid I would lose them. Shifting Mental Health to the county would be terrible. The county is notorious for being ineffectual when it comes to Mental Health issues, let alone non specialist issues.

February 22, 2012 at 10:48 AM

James Roache PharmD

Makes no sense. What's the point of doing a demonstration program to evaluate the system, if you are not going to complete the pilot before rushing off to a decision. Beside, everyone understands that no money to the state will be saved except on those patients who become lost in a premature decision. Ridiculous !! This is not how to govern nor manage a healthcare program.

Health plans rely on care coordinators and case managers to meet the social and medical needs of patients with complex conditions. Learn how plans invest in training to keep staff in these roles committed and sharp.